Individual provider Active NPI

Keitaroh Takeda

  • Emergency Medicine Physician
  • El Paso, TX
National Provider Identifier
1184076135
Registry record updated Jan 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
M-2357 Issued in GU
Practice address
4801 Alberta Ave
El Paso, TX 79905-2707
Phone
(915) 215-4625
NPI assigned
Jul 1, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X M-2357 GU Primary

Addresses

Primary practice location

4801 Alberta Ave
El Paso, TX 79905-2707

Mailing address

4801 Alberta Ave
El Paso, TX 79905-2707

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GU
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230306001591 GU Practitioner - Emergency Medicine 1951774322 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

133 Route 3
Dededo, GU 96929-6911
Phone (671) 645-5500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.22 of 100Reported as group
Quality
78.84
Improvement activities
40
Cost
61.61

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Guam Healthcare Development Incorporated CurrentSince Feb 20, 2023 Accepting new patients

Locations

133 Route 3
Dededo, GU 96929
Phone (671) 645-5500

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672617600000",
    "number": "1184076135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 ALBERTA AVE",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799052707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 ALBERTA AVE",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799052707",
            "telephone_number": "915-215-4625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKEDA",
        "first_name": "KEITAROH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-07-01",
        "last_updated": "2023-01-02",
        "certification_date": "2023-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GU",
            "license": "M-2357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.